Department of Health and Human Services 2017-2019 Biennial Budget - - PowerPoint PPT Presentation
Brian Sandoval Richard Whitley Governor Director State of Nevada Department of Health and Human Services 2017-2019 Biennial Budget Presentation Division of Health Care Financing and Policy Marta Jensen, Acting Administrator Betsy Aiello,
Helping People. It’s who we are and what we do.
Brian Sandoval Governor Richard Whitley Director
State of Nevada
Department of Health and Human Services
2017-2019 Biennial Budget Presentation Division of Health Care Financing and Policy Marta Jensen, Acting Administrator Betsy Aiello, Deputy Administrator Melissa Lewis, Chief, Fiscal Services February 22, 2017
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Mission Statement
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Governor’s Priorities and Performance Based Budget Strategic Priority – Educated and Healthy Citizenry: Health Services - Programs and services that help Nevadans and their communities achieve optimum lifelong health, including physical, mental, and social well-being, through prevention and access to quality, affordable healthcare. The Division of Health Care Financing and Policy works in partnership with the Centers for Medicare & Medicaid Services (CMS) to assist in providing quality medical care for eligible individuals and families with low income and limited resources. Services are provided through a combination of traditional fee-for-service provider networks and managed care organizations.
Goals
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Organizational Chart
Marta Jensen Acting Administrator U4610
Fiscal Services Karen Salm ASO IV Gr 44 Program and Field Ops Betsy Aeillo Deputy Administrator U4612 Human Resources Suzanne Webb PA II Gr 34 Accounting & Budget Cost Containment Program Integrity Tammy Moffitt SSC III Gr 41 Information Services Sandie Ruybalid ITM II Gr 42 Long Term Support & Services Jennifer Frischmann SSC III Gr 41 Policy Development & Program Management Shannon Sprout SSC III Gr 41 IT Operations Surveillance & Utilization Review (SUR) Provider Enrollment HIPAA / Recipient Civil Rights Electronic Health Records Audits Home Health, Private Duty Nursing, PCS, ISO & ADHD Indian Health, School Based Services, Therapy & Dental PERM, Systems & Internal Audits HCBS Waivers, Disability Determinations & Katie Beckett ICF/MR, Nursing Facilities, Out of State Placements, Hospice & PASRR Pharmacy & DME MMIS & Fiscal Reporting & Audits Health Care Reform Benefit Plan, Hospital, Therapy & Outpatient Services Fiscal Integrity Russell Steele SAII Gr 38 Innovation & Contracts Gloria Macdonald ASO III Gr 41 Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) Behavioral Health Recoupment and Recovery Management Application Development Project Management Business Process Analysis Facility Outreach and Community Integration Services (FOCIS) MCO Eligibility & Enrollment Contract Audits (MCO, Fiscal Agent) Budget & Accounting Melissa Lewis ASO III Gr 41 Home and Community Based Waiver QA Rate Analysis & Payments Deb Sisco MAIV Gr 39 Division Compliance Lynne Foster MAIV Gr 39 Hearings Document Control Corrective Action Oversight Medicaid Estate Recovery Applied Behavioral Analysis Health Care Guidance Program Non-Emergency Transportation Nevada Check Up Managed Care Contracts Supplemental Payments MCO and Medicaid Quality Tammy Ritter SSCIII GR41 Managed Care Quality FFS Quality Health Information Technology & Systems David Stewart CITM Gr 44 Electronic Health Records David Joseph MAIII Gr 37 Health Information Exchange (HIE) Davor Milicivic MAIII Gr 37 Predictive Health Analytics Verl Humphries Econ III Gr 37 Dental Benefit Administrator Oversight Data Quality & Requests Procurement & Project Management Rate Development Tiffany Lewis MAIV Gr 39 Las Vegas District Office Heather Lazarakis SSMIII Gr 39 Reno, Carson City & Elko District Offices Linda Bowman SSMIII Gr 39 Helping People. It’s who we are and what we do.
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Medicaid Caseload
567,952 676,885 687,515 100,000 200,000 300,000 400,000 500,000 600,000 700,000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 Jul-02 Jan-03 Jul-03 Jan-04 Jul-04 Jan-05 Jul-05 Jan-06 Jul-06 Jan-07 Jul-07 Jan-08 Jul-08 Jan-09 Jul-09 Jan-10 Jul-10 Jan-11 Jul-11 Jan-12 Jul-12 Jan-13 Jul-13 Jan-14 Jul-14 Jan-15 Jul-15 Jan-16 Jul-16 Jan-17 Jul-17 Jan-18 Jul-18 Jan-19 Total Medicaid
January 2017 Projections
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Medicaid Caseload by Population Type
100,000 200,000 300,000 400,000 500,000 600,000 700,000 Moms and Kids Aged, Blind, and Disabled Newly Eligible Parent-Caretakers Childless Adults Other
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Blended Federal Medical Assistance Percentage (FMAP)
Updated September 2016
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8 51,761,809 4.4% 2,269,102 0.2% 1,124,746,201 95.4%
2015-2017 Biennium
Legislatively Approved
Administration Nevada Check Up Medicaid
$1,178,777,112
54,207,668 3.8% 1,017,691 0.1% 1,381,193,985 96.2%
$1,439,679,246*
* E877 Supplemental Appropriation omitted from total.
General Fund Comparison by Budget Account
2017-2019 Biennium
Governor Recommends
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2017-2019 Biennium Budget Account Summary
General Fund Other Funds Total # of FTE General Fund Other Funds Total # of FTE 3157 Intergovernmental Transfer
164,306,632
165,956,756
29,461,880 152,462,253 181,924,133 295.51 28,005,690 143,871,299 171,876,989 295.51 3160 Increased Quality of Nursing Care
33,807,326
35,276,443
509,555 50,631,577 51,141,132
52,936,602 53,444,738
659,743,519 2,952,104,464 3,611,847,983
3,089,335,882 3,810,786,348
3,353,312,252 4,043,027,206 295.51 749,964,292 3,487,376,982 4,237,341,274 295.51
TOTAL
BA Budget Account Name
* BA 3158 includes G02 One Shot Appropriations
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Account established to receive funds provided by governmental entities to be used as the state share for a variety of supplemental payment programs. Current programs that have a State Net Benefit (SNB) are:
Total State Net Benefit (SFY16 SNB $43.4 million) SFY18 - $49,372,743 SFY19 - $49,246,127
E277 – Clark County Voluntary Contribution Rate
Increase the voluntary contribution rate from 47.5% to 50%
SFY18 Total Cost - $3,478,760 State General Funds - $0 SFY19 Total Cost - $3,541,291 State General Funds - $0
Intergovernmental Transfer (IGT) – BA3157
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New Positions – BA3158
M501 – Access to Care Reviews and Reporting
Two Management Analyst 2 positions to fulfill new reporting and monitoring requirements for State Medicaid programs.
SFY18 Total Cost - $458,801 State General Funds - $229,400 SFY19 Total Cost - $495,450 State General Funds - $247,725
M502 – Managed Care Organization (MCO) Quality
Three new Management Analyst positions to comply with quality reporting and monitoring regulations.
SFY18 Total Cost - $926,376 State General Funds - $285,688 SFY19 Total Cost - $273,491 State General Funds - $136,745
E240 – Division of Aging and Disability Services (ADSD) Claims Review
One new Administrative Assistant position and three new Management Analyst positions to assist the Division of Aging and Disability Services.
SFY18 Total Cost - $266,480 State General Funds - $133,240 SFY19 Total Cost - $337,037 State General Funds - $168,518
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New Positions – BA3158
E227 – Compliance Deputy
New Compliance Deputy position to support DHCFP activities.
SFY18 Total Cost - $(35,027) State General Funds - $(17,513) SFY19 Total Cost - $(11,594) State General Funds - $(5,797)
E225 – Actuary
New Actuary position to support DHCFP activities.
SFY18 Total Cost - $67,409 State General Funds - $33,705 SFY19 Total Cost - $306 State General Funds - $153
E226 – Housing Coordinator
New Housing Coordinator position to support Money Follows the Person (MFP) Grant.
SFY18 Total Cost - $71,213 State General Funds - $0 SFY19 Total Cost - $89,540 State General Funds - $0
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G02 – One Shot Appropriation MMIS Replacement – BA3158
Continuation and completion of Phase III of the Medicaid Management Information System (MMIS) Replacement Project. Phase III, Design, Development and Implementation (DDI) – Design, development and deploy automated solutions and fiscal agent services to support the Nevada Medicaid program. Begin implementation of Medicaid Information Technology Architecture (MITA) aligned solution(s) compliant with CMS certification criteria. Final deployment is scheduled for SFY18 and CMS certification is scheduled for SFY19. Estimated Costs Total Computable – Funding is majority 90/10 split with 10% State General Fund.
SFY18 Total Cost - $18,291,605 State General Funds - $2,658,832 SFY19 Total Cost - $5,526,681 State General Funds - $601,070
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M202 – Individuals with Intellectual Disabilities (IID) Waiver Slots
SFY 2018 – 96 Slots SFY 2019 – 110 Slots Total – 206 Slots
SFY18 Total Cost - $8,981 State General Funds - $2,245 SFY19 Total Cost - $31,581 State General Funds - $7,895
M203 – Frail/Elderly (FE) Waiver Slots
SFY 2018 – 116 Slots SFY 2019 – 131 Slots Total – 247 Slots
SFY18 Total Cost - $11,317 State General Funds - $2,829 SFY19 Total Cost - $40,459 State General Funds - $10,115
M204 – Physically Disabled (PD) Waiver Slots
SFY 2018 – 24 Slots SFY 2019 – 36 Slots Total – 60 Slots
SFY18 Total Cost - $1,769 State General Funds - $442 SFY19 Total Cost - $9,462 State General Funds - $2,366
Waiver Caseload Growth – BA3158
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M540 – Individuals with Intellectual Disabilities (IID) Waiver Slots
SFY 2018 – 106 Slots SFY 2019 – 105 Slots Total – 211 Slots
SFY18 Total Cost - $11,799 State General Funds - $2,950 SFY19 Total Cost - $33,581 State General Funds - $8,395
M513 – Frail/Elderly (FE) Waiver Slots
SFY 2018 – 78 Slots SFY 2019 – 77 Slots Total – 155 Slots
SFY18 Total Cost - $8,655 State General Funds - $2,164 SFY19 Total Cost - $24,660 State General Funds - $6,165
M514 – Physically Disabled (PD) Waiver Slots
SFY 2018 – 26 Slots SFY 2019 – 27 Slots Total – 53 Slots
SFY18 Total Cost - $2,954 State General Funds - $738 SFY19 Total Cost - $8,398 State General Funds - $8,398
Waiver Waitlist Reduction – BA3158
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M101 – Increases for Inflation
Agency Specific Inflation Rate Increases.
SFY18 Total Cost - ($92,828) State General Funds - $502,553 SFY19 Total Cost - ($656,414) State General Funds - $ 1,588,647
M200 – Increases for Caseload
Total Medicaid and Nevada Check Up caseload is projected to increase from the legislatively approved caseload of 587,984 to 679,043 at the end of SFY17, an increase of 91,059.
SFY18 Total Cost - $3,955,999 State General Funds - $1,136,029 SFY19 Total Cost - $3,955,999 State General Funds - $1,136,018
M201 – Increases for Caseload
Total Medicaid and Nevada Check Up caseload is projected to increase from 679,043 at the end of SFY17 to 693,287 in SFY18 and 710,006 in
(4.56 percent) in SFY19.
SFY18 Total Cost - ($1,161,283) State General Funds - ($201,125) SFY19 Total Cost - $464,879 State General Funds - $241,106
Administration Increases – BA3158
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Administration – BA3158
E671 – IT Administration
One grade increase for IT personnel.
SFY18 Total Cost - $61,259 State General Funds - $30,629 SFY19 Total Cost - $63,085 State General Funds - $31,542
E710 – Computer Hardware Replacement
Replacement per EITS schedule.
SFY18 Total Cost - $305,266 State General Funds - $152,633 SFY19 Total Cost - $172,091 State General Funds - $86,046
E720 – New Equipment
Replacement per schedule.
SFY18 Total Cost - $54,924 State General Funds - $27,462 SFY19 Total Cost - $39,744 State General Funds - $19,873
E800 – Payments to Sister Agencies
SFY18 Total Cost - $(1,153,213) State General Funds - $109,853 SFY19 Total Cost - $(296,435) State General Funds - $109,852
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The 2003 Legislature instituted a Long Term Care (LTC) provider tax on freestanding long term care facilities to increase the quality of long term nursing care in Nevada. The tax rate is based on 6% of net patient revenues. The proceeds of the tax are used to make monthly supplemental payments to skilled nursing facilities caring for Medicaid recipients. SFY18
SFY19
Increased Quality of Nursing Care – BA3160
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Nevada Check Up Caseload – BA3178
5,000 10,000 15,000 20,000 25,000 30,000 5,000 10,000 15,000 20,000 25,000 30,000 Jul-13 Jan-14 Jul-14 Jan-15 Jul-15 Jan-16 Jul-16 Jan-17 Jul-17 Jan-18 Jul-18 Jan-19 Nevada Check Up
Governor's Recommend. January 2017 Projection 27,560 18,980 25,347
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M200 – Increases for Caseload
Caseload is projected to increase from the legislatively approved caseload of 18,980 to 25,048 at the end of SFY17, an increase of 6,068 (31.97 percent).
SFY18 Total Cost - $3,912,784 State General Funds - $41,265 SFY19 Total Cost - $3,912,784 State General Funds - $38,880
M201 – Increases for Caseload
Caseload is projected to increase from 25,048 at the end of SFY17 to 25,216 in SFY18 and 25,347 in SFY19. This is an increase of 168 (0.67 percent) in SFY18 and 299 (1.19 percent) in SFY19.
SFY18 Total Cost - $846,760 State General Funds - $9,821 SFY19 Total Cost - $1,175,969 State General Funds - $12,933
Nevada Check Up Caseload – BA3178
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M101 – Increases
Mandatory increases for Nevada Check Up, Managed Care Organizations, Federally Qualified Health Centers, Rural Health Centers as well as inflations for prescription drugs.
SFY18 Total Cost - $2,644,235 State General Funds - $30,673 SFY19 Total Cost - $4,604,445 State General Funds - $50,648
E290 – Pediatric Surgery Rate Increase
15% rate increase for pediatric surgery services.
SFY18 Total Cost - $22,719 State General Funds - $263 SFY19 Total Cost - $23,255 State General Funds - $256
Nevada Check Up Increases – BA3178
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M200 – Increases for Caseload
Caseload is projected to increase from 632,641 at the end of fiscal year 2016 to 684,215 at the end of fiscal year 2019, an increase of 51,574.
SFY18 Total Cost - $478,379,038 State General Funds - $70,555,807 SFY19 Total Cost - $574,792,188 State General Funds - $102,279,149
Medicaid Caseload – BA3243
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Rate Increases – BA3243
M101 – Agency Specific Inflation Rate Increases 2018 and 2019
2.59% each fiscal year for Managed Care Organizations. 3.6% in 2018 and 4.0% in 2019 for Pharmacy, Hospice, Rural Health Centers, and Federally Qualified Health Centers and 6.96% for Indian Health Services each fiscal year.
SFY18 Total Cost - $95,072,611 State General Funds - $27,264,222 SFY19 Total Cost - $167,344,765 State General Funds - $45,467,522
M528 – Individuals with Intellectual Disabilities (IID) Waiver Supported Living Arrangement Rates
Federal funding to support a behavioral complex rate in ADSD budget.
SFY18 Total Cost - $946,448 State General Funds - $0 SFY19 Total Cost - $947,640 State General Funds - $0
E290 – Pediatric Surgery Rates
15% rate increase for pediatric surgery services.
SFY18 Total Cost - $845,067 State General Funds - $215,392 SFY19 Total Cost - $945,458 State General Funds - $240,758
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Rate Increases – BA3243
E275 – Adult Day Health Care Rates
5% rate increase for Adult Day Health Care services.
SFY18 Total Cost - $729,066 State General Funds - $250,215 SFY19 Total Cost - $742,708 State General Funds - $254,359
E276 – Assisted Living Rates
15% rate increase for Assisted Living services, and the addition of a level 4 for the behaviorally complex patients.
SFY18 Total Cost - $3,140,593 State General Funds - $1,084,133 SFY19 Total Cost - $3,140,593 State General Funds - $1,081,620
E285 – Skilled Nursing Facility & Swing Bed Rates
10% rate increase for Skilled Nursing Facilities and Swing Bed services.
SFY18 Total Cost - $11,956,865 State General Funds - $2,663,113 SFY19 Total Cost - $12,246,221 State General Funds - $2,726,006
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New Services – BA3243
M504 – Home Health & Durable Medical Equipment (DME) Services
Expansion of CMS’ definition of Medical Supplies, Equipment, and Appliances to include "suitable for use in any non-institutional setting in which normal life activities take place". Additional face-to-face visit to be completed allowing for a recipient to obtain medical justification for an item up to 30 days after the item has been supplied.
SFY18 Total Cost - $4,633,151 State General Funds - $1,510,829 SFY19 Total Cost - $5,516,044 State General Funds - $1,797,890
M506 – Transgender Services
Expanded services associated with the coverage of hormone suppression, hormone therapy, and psychotherapy to include gender reassignment surgery for the transgender population.
SFY18 Total Cost - $620,454 State General Funds - $181,802 SFY19 Total Cost - $635,470 State General Funds - $186,802
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New Services – BA3243
E281 – Medical Nutrition Therapy (MTN)
Addition of MTN services through the use of Registered Dieticians.
SFY18 Total Cost - $3,011,078 State General Funds - $696,248 SFY19 Total Cost - $3,108,753 State General Funds - $726,391
E282 – Adult Podiatry
Addition of Adult Podiatry services.
SFY18 Total Cost - $269,034 State General Funds - $71,335 SFY19 Total Cost - $277,761 State General Funds - $74,253
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M202 – Individuals with Intellectual Disabilities (IID) Waiver Slots
SFY 2018 – 96 Slots SFY 2019 – 110 Slots Total – 206 Slots
SFY18 Total Cost - $1,739,358 State General Funds - $147,442 SFY19 Total Cost - $6,121,990 State General Funds - $517,746
M203 – Frail/Elderly (FE) Waiver Slots
SFY 2018 – 116 Slots SFY 2019 – 131 Slots Total – 247 Slots
SFY18 Total Cost - $2,530,385 State General Funds - $873,489 SFY19 Total Cost - $9,039,438 State General Funds - $3,113,182
M204 – Physically Disabled (PD) Waiver Slots
SFY 2018 – 24 Slots SFY 2019 – 36 Slots Total – 60 Slots
SFY18 Total Cost - $125,144 State General Funds - $43,200 SFY19 Total Cost - $672,081 State General Funds - $231,465
Waiver Caseload Growth – BA3243
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M540 – Individuals with Intellectual Disabilities (IID) Waiver Slots
SFY 2018 – 106 Slots SFY 2019 – 105 Slots Total – 211 Slots
SFY18 Total Cost - $2,286,652 State General Funds - $193,835 SFY19 Total Cost - $6,510,469 State General Funds - $550,601
M513 – Frail/Elderly (FE) Waiver Slots
SFY 2018 – 78 Slots SFY 2019 – 77 Slots Total – 155 Slots
SFY18 Total Cost - $1,935,503 State General Funds - $668,136 SFY19 Total Cost - $5,508,738 State General Funds - $1,897,209
M514 – Physically Disabled (PD) Waiver Slots
SFY 2018 – 26 Slots SFY 2019 – 27 Slots Total – 53 Slots
SFY18 Total Cost - $209,612 State General Funds - $ 72,358 SFY19 Total Cost - $596,588 State General Funds - $205,465
Waiver Waitlist Reduction – BA3243
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Efficiencies in Government – BA3243
E225 – ADSD Nevada Early Intervention Services
Service model change where the state operated program provides eligibility, service coordination and service authorization, and contracted providers provide the therapy costs included in the Individualized Family Service Plan. (Companion to ADSD cost savings decision unit)
SFY18 Total Cost - $6,482,937 State General Funds - $2,237,910 SFY19 Total Cost - $8,027,097 State General Funds - $2,764,533
E228 – ADSD Autism Treatment Assistance Program Services
Increased utilization of services provided are eligible for Medicaid
SFY18 Total Cost - $2,808,954 State General Funds - $969,651 SFY19 Total Cost - $3,651,641 State General Funds - $1,257,625
E277 – Clark County Voluntary Contribution Rate
Increase the voluntary contribution rate from 47.5% to 50%. State General Funds are offset by Intergovernmental Transfer.
SFY18 Total Cost - $0 State General Funds - $0 SFY19 Total Cost - $0 State General Funds - $0
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Bill Draft Request Summary
Budget BDR Summary BDR # NRS Description Impact 17A4031587 422 Allow the Division to assess each health care provider group a fee to improve the quality and access to health care services in Nevada. Loss of maximization of federal funds to support additional supplemental payment programs.
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Acronyms
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ABA – Applied Behavioral Analysis ACA – The Affordable Care Act CMS – Centers for Medicare and Medicaid EPSDT – Early Periodic Screening, Diagnostic, and Treatment FE – Frail/Elderly FMAP – Federal Medical Assistance Percentage HCBS – Home and Community-Based Services HHS – U.S. Department of Health and Human Services IID – Individuals with Intellectual Disabilities LTSS – Long-Term Supports and Services MCO – Managed Care Organization MITA – Medicaid Information Technology Architecture MLTSS – Managed LTSS NET – Non-emergency transportation PD – Physically Disabled SNB – State Net Benefit
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Medical
$3,271,341,786
Operations
$43,877,517
Fiscal Agent
$43,755,813
Other
$64,127,981
Total Computable Spend:$3,423,103,097
ADMIN OTHER $64,127,981 (Majority of these funds are pass through of federal dollars to sister & state agencies for administrative services)
SFY16 Total Computable Spend by Type
Medical (Medicaid and Nevada Check Up) $3,271,341,786 95.57% DHCFP Operations $43,877,517 1.28% DHCFP Fiscal Agent $43,755,813 1.28% Public and Behavioral Health $1,542,423 0.05% Division of Welfare and Supportive Services $49,956,597 1.46% Division of Aging Admin $10,449,053 0.31% Local Governments/Administrative Claiming $900,259 0.03% Division of Child and Family Services $1,026,342 0.03% Directors Office $204,410 0.01% Department of Administration $28,097 0.00% Transfer to Legislative Council Bureau $20,800 0.00% TOTAL $3,423,103,097 100.00%
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SFY16 FFS Medicaid Cost by Budget Category
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Fee For Service 28% Managed Care 72%
Medicaid Caseload Breakdown
AmeriGroup 41% Health Plan
59%
Managed Care Breakdown
DECEMBER 2016 MEMBERS
Managed Care: 462,122 FFS: 175,379 TOTAL: 637,501
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SFY16 MCO Top 10 Services by Expenditures
Provider Type Sum of Net Payment % of Expenditures 020 - Physician 287,758,759.55 $ 27.15% 028 - Pharmacy 226,022,619.20 $ 21.32% 011 - Inpatient Hospital 149,730,850.67 $ 14.12% 010 - Outpatient Surgery 125,488,044.10 $ 11.84% 022 - Dental 33,561,244.08 $ 3.17% 014 - Behavioral Health Outpatient 26,257,119.66 $ 2.48% ~ Financial Transactions 24,102,805.23 $ 2.27% 035 - Ambulance - Air or Ground 19,693,899.34 $ 1.86% 013 - Inpatient Psychiatric Hospital 17,197,950.07 $ 1.62% 012 - Outpatient Hospital 16,374,207.93 $ 1.54%
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SFY16 FFS Top 10 Services by Expenditures
Provider Type Sum of Net Payment % of Expenditures 011 - Inpatient Hospital 266,342,463.96 $ 16% 028 - Pharmacy 258,129,046.94 $ 16% 020 - Physician 174,672,277.26 $ 11% 019 - Nursing Facility 141,130,587.78 $ 9% 014 - Behavioral Health Outpatient 128,286,366.64 $ 8% 038 - Intellectual Disability Waiver 96,409,603.88 $ 6% 030 - Personal Care Aid Agency 88,926,190.74 $ 5% 022 - Dental 49,528,587.79 $ 3% 012 - Outpatient Hospital 43,871,730.07 $ 3% 054 - Targeted Case Management 43,756,145.25 $ 3%
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SFY16 MCO/FFS Top 10 Services by Expenditures
Provider Type Sum of Net Payment % of Expenditures 028 - Pharmacy 484,151,666.14 $ 18.09% 020 - Physician 462,431,036.81 $ 17.27% 011 - Inpatient Hospital 416,073,314.63 $ 15.54% 014 - Behavioral Health Outpatient 154,543,486.30 $ 5.77% 019 - Nursing Facility 149,926,859.92 $ 5.60% 010 - Outpatient Surgery 129,956,016.15 $ 4.85% 038 - Intellectual Disability Waiver 96,409,603.88 $ 3.60% 030 - Personal Care Aid Agency 89,831,535.19 $ 3.36% 022 - Dental 83,089,831.87 $ 3.10% 012 - Outpatient Hospital 60,245,938.00 $ 2.25%
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SFY16 Top 10 Medicaid Services by Expenditures
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SFY16 Top 10 Services by Expenditures – FFS Traditional Medicaid Population
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SFY16 Top 10 FFS Services by Expenditures – Aged Population
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SFY16 Top 10 Services by Expenditures – Blind Population
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SFY16 Top 10 Services by Expenditures – Disabled Population
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Medicaid Rates
rolling basis, some more frequently, due to State Plan language, provider or legislative requests.
and recommendations are put forward based on the analysis.
reported by February 1st of each year pursuant to NRS 232.354.
may require additional State General fund appropriations from Legislature.
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Medicaid Rate Methodologies
Rates based on a set year CMS conversion factor and the associated value units assigned by individual procedure code. A percentage of the full rate is paid based on the methodologies listed in the State Plan (Examples include Physician or Nurse Practitioner).
Rates are set based on Medicaid allowable costs as defined in Federal Regulations (Examples include Free Standing Psychiatric Facilities or Skilled Nursing Facilities).
Select Provider Types such as Critical Access Hospitals (CAH) are cost settled. Providers receive an interim rate based on the previous year's costs.
The 2001 Legislative Session enacted A.B. 513 that created a Provider Rates Task
were adopted by the DHCFP August 15, 2002.
Negotiated rates are sometimes necessary in special situations such as access to care or difficult placement. Both facility specific and patient specific rates can be negotiated.